Currently, there are three multi-specialty certifying bodies recognized within our health care system. The American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), and the American Board of Physician Specialties (ABPS). Albeit we state there are three, for some time the ABMS has been certifying osteopathic physicians with AOA in practice coming into the fold.
We constantly speak of the crisis of physician shortages. Yet, crisis or no crisis, there simply is no reason to impede patient access to physician care based upon physician board certification. This happens all too often, even during the greatest pandemic our nation has seen in over one hundred years.
Even then, the all too well-known discriminatory and monopolistic practices of the ABMS continued, placing patient safety and care at risk. While it is important for physicians to be board-certified, it does not mean that they must only be certified by the ABMS.
During the COVID-19 crisis, while we fought against a severe shortage of physicians, many hospitals knowingly or unknowingly required ABMS only board-certified physicians in emergency medicine. These discriminatory hiring practices turned away highly skilled and qualified physicians, many of whom were dually board-certified by ABMS in a primary specialty and ABPS in emergency medicine.
Do these ongoing monopolistic practices truly place patient safety and care first? Or, does it place a powerful monopoly’s revenues before what we are supposed to care for — who are our patients?
The ABMS claims to be a “non-profit” organization that certifies physicians and controls some of the largest specialties such as the American Board of Internal Medicine as well as the American Board of emergency medicine along with 22 other medical specialties (not including the over 70 subspecialties they control as well).
Additionally, the ABMS maintenance of certification (MOC) requirement for physicians each year while placing their revenue at over one billion dollars — all for a “non-profit” entity.
In major cities — like New York, the hardest hit in the U.S. during the first COVID lockdown — while the governor and hospitals were calling up retired physicians along with last year med students into their emergency departments, highly skilled physicians board-certified by the ABPS were being turned away. In Detroit, another hard-hit metropolitan area, hospitals were in desperate need of physicians for their ERs and placing ads that required ABMS emergency medicine physicians only.
Of course, no one wants an unqualified physician treating anyone. But it’s important to note that the non-ABMS doctors who could be filling many vacancies across the country are certified by other reputable physician certifying bodies. It is important to note that the physician board certification is not, nor has it ever been, a requirement of licensure.
Simply put, the danger the ABMS monopoly poses was highlighted during the COVID-19 crisis within cities like New York and Detroit. Their control limited patient access to care as non-ABMS physicians willing to provide emergency and telemedicine services were turned away for not being ABMS board-certified physicians.
Creating barriers to patient access to physician care only exacerbates physician shortages. Denying patients access to a physician based on board certification should not happen. For many, these practices are all too often based upon the fact that a physician may not have chosen the “cool-kids table” to sit at. For many physicians, these practices are all too well known and just accepted, yet they never should be, nor should they ever be allowed, especially during the COVID-19 pandemic.
As we move forward, we must ask ourselves why did this happen? How can we ensure this never happens again? What are the true dangers to patient safety and care when a physician monopoly such as the ABMS takes hold?
When we hear the word “monopoly,” we usually think of the industries such as business and big tech and not health care.
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So what is the word “monopoly” doing in physician care?
More often than not, monopolies lead to a money trail. When a non-profit entity maintains hundreds of millions in revenue, it should lead us all to question motive. That one billion dollars of the ABMS’s revenue must be going somewhere. The chances are slim that all of that money is going towards battling the COVID crisis.
Starting from the ABMS’ stronghold on all United States residency training programs (both medical and surgical) that require all of their graduating residents to only take the ABMS boards upon completion of their residency to now punishing patients and deny them quality care from outstanding ABPS-certified physicians. This monopoly of the ABMS must once and forever stop. Our lives depend on it.
This article is discussed on The Podcast by KevinMD in the episode Certified, but denied: the impact of board certification on patient care.
This essay is cited in the KevinMD record on board certification.
Emmanuel K. Konstantakos is an orthopedic surgeon.
Image credit: Shutterstock.com
